Conference Coverage

Bringing up the rear: Disorders of the rectum and colon


 

The final session of the course opened with Uri Ladabaum, MD, entertaining the question “Colon cancer screening and surveillance: who, when, and how?” Dr. Ladabaum pointed out that there is consensus that colorectal cancer screening for average-risk individuals should begin at age 50 with a choice of modalities and that surveillance depends on the findings on each colonoscopy. He reviewed the evidence for screening modalities and for surveillance and offered perspectives on the role of the gastroenterologist/colonoscopist in the quality of colonsocopy. Douglas K. Rex, MD, AGAF followed by asking “Does every big polyp need EMR?” Dr. Rex discussed the available approaches to the large colonic polyp, including endoscopic mucosal resection, endoscopic submucosal dissection, and surgery. He provided evidence for the advantages and expanded use of EMR, with the conclusion that almost every large benign polyp needs EMR.

Dr. David E. Cohen
Dr. David E. Cohen
Asyia Ahmad, MD followed with a talk entitled, “When in Rome: Update on the Rome IV criteria for functional bowel disorders.” Dr. Ahmed explained that the 2016 Rome IV classification of functional GI disorders describes a spectrum of disorders instead of the distinct ones in Rome III. Additionally, the importance of culture and language is now taken into account, with descriptions of symptoms that occur in these contexts. Novel areas of research and concepts comprise biopsychosocial, clinical applications, the patient-physician relationship, and therapies aimed at brain-gut interactions. Such therapies include cognitive-behavioral therapy, hypnosis, relaxation techniques, psychodynamic therapy, biofeedback, and mindfulness.

Jennifer A. Christie, MD, then spoke on “Pelvic floor dysfunction and constipation.” Dr. Christie stressed the importance of a good history and the digital rectal exam in diagnosis of pelvic floor dysfunction. When over-the-counter or prescribed medications are not effective, the work-up should include anorectal manometry, balloon expulsion, and colonic transit testing. Attempts should be made to remove all potential offending agents, such as anticholinergics, narcotics, calcium channel blockers, and beta-blockers. Biofeedback is a safe and effective treatment for pelvic floor dysfunction. Lin Chang, MD, AGAF, continued with a talk on irritable bowel syndrome, which can be considered a combination of disorders, with clusters of symptoms and subgroups. There must be recurrent abdominal pain or discomfort at least 1 day/week for the prior 3 months, associated with 2 or more of the following: a relationship to defecation, change in stool frequency, or stool form/appearance. Risk includes genetic and environmental factors, stress/abuse, and acute gastroenteritis. After a structured evaluation, a graded treatment response is undertaken, ranging from diet/lifestyle counseling to pharmacotherapy to psychological therapies.

Neil Hyman, MD, concluded the session with a talk entitled “Disorders of the anorectum,” also stressing that the history is key to the diagnosis, with an emphasis on asking the right questions. Pain may be related to fissures, thrombosed hemorrhoids, abscesses, and proctalgia/levator spasm. New technologies, and pharmacological and surgical approaches were discussed.

This is a summary provided by the moderator of one of the AGA Postgraduate Courses held at DDW 2017. Dr. Cohen is the chief of the division of gastroenterology and hepatology in the Weill department of medicine, New York–Presbyterian Hospital Center, New York.